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8.12 Ageing with an amputation
from Guidance on the support pathway for people with a limb amputation (and trialling a prosthesis)
by icarensw
In this guidance, the focus is on people with a limb amputation as a result of traumatic injury, who are typically under 65 years old. Most people undergoing an amputation have chronic peripheral vascular disease or diabetes and are over 65 years of age [76, 77]. For people with diabetes and chronic peripheral vascular disease, the experience of amputation with further ageing is quite different to the experiences of the target population of the guidance. However, the guidance is informed by research on limb amputation generally, ageing and, in particular, ageing with a disability.
As any person gets older, they must adjust to underlying changes to functioning such as movement, sensory function, cognitive function, immune function and sexuality [78, 79]. The WHO World Report on Ageing and Health draws on the data from the Global Burden of Disease project (2013) and identifies common causes of years of healthy life lost due to disability in people older than 60 years.
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The data shows that the greatest burden is from [79]:
• sensory impairments (vision and hearing) • back and neck pain • chronic obstructive pulmonary disease • depressive disorders • injury related to falls • diabetes • dementia • osteoarthritis. More than half of older people are affected by co-occurring health conditions, which particularly occur between the ages of 50 and 60 years and in advanced older age [79].
For a person with an amputation, any of these common health conditions in combination with their amputation can have an impact on their functioning as they age. Walking and mobility may be particularly affected if the person has a lower limb amputation.
Like others with existing mobility impairment, a person with lower limb amputation may experience earlier functional loss as they age [36]. People with lower limb amputation are already vulnerable to falling, with up to 50% experiencing a fall every year [80]. People ageing with an amputation can be even more vulnerable to some co-occurring health conditions such as weight increase (refer to Section 8.13), diabetes (refer to Section 10.2) and falls [80]. How people age with an amputation is also influenced by their age at the time of amputation; their context and living situation; their health, fitness and function before the amputation; connected health issues (refer to Section 9) they experience because of the amputation, such as phantom limb pain; and health issues co-occurring at the time of injury (refer to Section 10) [36, 77, 78, 81, 82].
In the longer term, age-related health conditions may influence or complicate the use of the prosthesis. For example, for a person with a highlevel amputation (transfemoral versus transtibial), cognitive impairment or depression can make ageing more complicated [74, 82-84]. Across all older amputees, irrespective of the reason for the amputation, the person benefits from rehabilitation, and fitting of a prosthesis results in a better quality of life and the person using their prosthesis every day [74, 76, 83, 85, 86]. Each person should be provided with the same opportunities for prosthetic fitting and trial (if they choose to do so and a multidisciplinary assessment concurs), as well as rehabilitation and supports, irrespective of their age [87-89].
The person needs to be reviewed in their home environment and undertaking their daily activities. It is appropriate for the person to re-engage with a multidisciplinary team including peer support workers early and to seek support to prevent complications (e.g. from falls). After review by the GP, a re-referral to the multidisciplinary team may be needed if the person’s contact with the team has lapsed.
Recommendations
17 Each person should undergo an individualised multidisciplinary assessment of their potential to use a prosthesis, including the older person with limb amputation.
18 Any known age-related risk factors (e.g. sensory impairments, falls, diabetes, dementia, arthritis) should be assessed at times of screening or monitoring, during reviews with the multidisciplinary health professionals, and at the least annually with the GP (refer to Recommendation 16). Consensus
Grade
BQ
Best practice note—7
Ageing with an amputation
The key common issues relevant to someone ageing with an amputation that can be prevented or diminished, or for which compensatory strategies can be used, are: • arthritis • psychosocial and mental health • balance and risk of falls • skin care • weight control • cardiovascular disease and fitness • memory and cognition.
For most people as they age, maintaining their health, lifestyle and independence is important to them and their family. The person, carer and multidisciplinary team should focus on supporting the person to perform actions and adopt routines, and providing equipment, supports or services, that maintain, diminish or prevent factors that can be influenced (e.g. weight control and prevention of diabetes, fall minimisation, stump hygiene to prevent complications).
Ageing with an amputation Information and resources for the person and their family • Coping with aging and amputation (How changing the way you think could change your health)
See: www.amputee-coalition.org/resources/coping_with_aging_and_amputation (Amputee Coalition -USA) • Aging gracefully with an amputation
See: opedge.com/Articles/ViewArticle/2012-12_03 (article from The O&P Edge)
