Amputations in Elders Explained
Most amputations (82%) in the United States are a result of peripheral vascular disease (PVD), also known as poor circulation. The next most common cause of amputation is due to complications in patients with diabetes.
After amputation, 60% of amputees live between 2 to 5 years after because of the risk of cardiovascular disease.
There are two broad amputations in elders classifications: non-neglect- and neglect-related reasons. Amputation that doesn’t involve neglect can result from medical, surgical or psychiatric causes. Surgical causes include injuries from combat or injuries from an accident.
Amputations in elders that involve neglect are due to improper care that leads to an amputation requirement.
Amputations in Elders From Neglect
In some cases, neglect has become so severe that it puts the patient at risk for amputation. Amputation resulting from neglect can be devastating for a patient because it results from a lack of care, which also results in emotional and psychological traumas.
It is important for patients at risk for amputation to follow strict guidelines for medical care to prevent amputation. Patients who are diabetic or suffer from PVD (peripheral vascular disease) are at high risk for amputation when their health is not properly maintained.
Common Elder Amputations
Lower extremity amputation (LEA) is the most common form of amputation in the elderly. Patients with diabetes are up to 10 times more likely to undergo an LEA.
The following are some common amputation procedures in elderly people:
Transtibial amputation is done near the middle to the upper tibia (shinbone). In elderly patients, if the knee can be saved it should. Amputation above the knee can make rehabilitation and exercise after amputation more difficult.
A transfemoral amputation, or above the knee amputation (AKA), is most common in the elderly. The risk associated with this type of amputation is extra stress on the cardiovascular system. The extra stress usually comes from the strength it takes to move a wheelchair with the upper arms.
Around 66% of diabetics who underwent one LEA require the second leg to be amputated within 5 years and 75% of LEA patients are male. An estimated 60% of elderly amputees discard their prosthesis within 6 months.
Partial Hand Amputation
Partial hand amputation is the amputation of a finger or thumb. Amputation of the thumb is the most common in the elderly and can affect the ability to hold and grasp items. This is often a difficult amputation because prosthetics for this area of the body are not always functional.
Amputations in Elders Signs and Symptoms
If a patient has diabetes or peripheral arterial disease (another term for PVD), they are at an increased risk of amputation. Certain signs indicate that a person is at risk of requiring an amputation and these symptoms should be monitored closely by nursing staff and caregivers.
If a patient experiences any of the following symptoms, it’s important to seek medical attention immediately as they are risk factors for amputation:
- Pain or numbness in the limb
- Slow-healing wounds and sores
- Shiny, smooth and dry skin on the limb
- Toenail or nail thickening
- Absent or weak pulse in the limb
- Infection in the limb unresponsive to antibiotics
Nearly all patients experience some form of painless phantom limb sensation.
Why Do Elders Require Amputation?
Amputations in elders are required for reasons related to either non-neglect or neglect. Non-neglect includes medical, surgical or psychiatric complications that lead to the limb not being able to be saved.
Medical non-neglect amputation can result from severe injury or trauma like a car accident or injury at a factory job. Non-neglect medical amputation can also result from the removal of a cancerous tumor or bone cancer. Neuroma, thickening of nerve tissue, can also require amputation. The most common causes of medical non-neglect amputation are PVD and diabetes.
Medical reasons for amputation include:
- Cancerous tumor
- Severe injury or trauma
- Neuroma (thickening of nerve tissue)
Accident-related amputation causes include:
- Injuries from a fall
- Motor vehicle collision
- Work-related construction accident
- Subway and train accident
Surgical non-neglect amputation can result from infection from previous surgery. Patients with diabetes or poor circulation, peripheral vascular disease, are at a much higher risk. Up to 30% of patients with soft tissue infections undergo partial or complete limb amputations.
Amputation as a result of a psychiatric condition is also a form of non-neglect. Burn victims and former military personnel who suffered traumatic injuries are at risk for amputation. Post-traumatic stress disorder (PTSD) can result in intense fear, horror, images of others being injured and startling sounds resurface during rehabilitation. Some veterans with PTSD end up requiring amputations.
Neglect-related amputations can occur when nurses and aids fail to perform thorough skin and body checks for open wounds. Improper wound care can result in bacteria getting into open wounds. The bacteria can kill tissue resulting in necrotic tissue, or dead tissue. Necrotic tissue can then result in gangrene, which is due to a lack of blood supply to the tissue.
Improper wound care can also result in pressure sores. Pressure sores happen when blood flow is cut off, often due to bedsores and even prosthetics that do not fit properly. It’s very important that patients diagnosed with peripheral arterial disease or diabetes be examined regularly for pressure sores.
Lawsuits Regarding Amputee Care in the Nursing Home
The following are some examples of cases of nursing home neglect that resulted in amputations in elders, leading the plaintiffs to be awarded compensation for damages:
- A Pennsylvania woman suffered a fractured leg. The case involved nursing home neglect that led to pressure sores and eventual amputation. The woman was awarded $65,000 in damages.
- A diabetic patient underwent knee replacement surgery and then developed a post-operative infection due to neglect and eventually leading to amputation. The patient was awarded damages of over $500,000.
- A wrongful death occurred to due neglectful care after an amputation. The family received $1.7 million in damages.
Amputation may not always be preventable. The care of someone leading up to amputation, after amputation as well as those at risk like patients with diabetes or peripheral arterial disease, is key to maintaining quality of life.
If you or a loved one is at risk or has suffered from neglect that resulted in amputation or death, please contact us for a free case evaluation.